Provider Demographics
NPI:1003319047
Name:BERTRAM, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:BERTRAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28092 COUNTY ROAD 12
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:MN
Mailing Address - Zip Code:56331-9755
Mailing Address - Country:US
Mailing Address - Phone:320-333-1869
Mailing Address - Fax:
Practice Address - Street 1:4000 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2364
Practice Address - Country:US
Practice Address - Phone:740-264-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program